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The Health Insurance Portability and Accountability
Act of 1996 (HIPAA) places strict limitations on pre-existing
condition exclusions for health insurance. Under HIPAA,
the only pre-existing conditions that may be excluded
under a pre-existing condition exclusion are those
for which medical advice, diagnosis, care or treatment
was recommended or received within the 6-month period
ending on the enrollment date. The exclusion can last
no more than 12 months (18 months for late enrollees).
The enrollment date is the first day of coverage, or
if there is a waiting period, the first day of the
waiting period. An employer needs to determine if the
savings from maintaining a pre-existing condition is
significant enough to justify one.
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